RESEARCH ARTICLE


Non-Operative Management of Rotator Cuff Tears



M. Petri1, *, M. Ettinger2, S. Brand1, T. Stuebig1, C. Krettek1, M. Omar1
1 Trauma Department Hannover Medical School (MHH) Carl-Neuberg-Straße 1 D-30625 Hannover, Germany
2 Orthopaedic Surgery Department Hannover Medical School (MHH) Anna-von-Borries-Str. 1-7 D-30625 Hannover, Germany


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© Petri et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Trauma Department, Hannover Medical School (MHH) Carl-Neuberg-Str. 1, D-30625 Hannover, Germany; Tel: +49 511 532 2050; Fax: +49 511 532 5877; E-mail: petri.maximilian@mh-hannover.de


Abstract

Background:

The role of nonoperative management for rotator cuff tears remains a matter of debate. Clinical results reported in the literature mainly consist of level IV studies, oftentimes combining a mixed bag of tear sizes and configurations, and are contradictory to some extent.

Methods:

A selective literature search was performed and personal surgical experiences are reported.

Results:

Most studies show an overall success rate of around 75% for nonoperative treatment. However, the majority of studies also present a progression of tear size and fatty muscle infiltration over time, with however debatable clinical relevance for the patient. Suggested factors associated with progression of a rotator cuff tear are an age of 60 years or older, full-thickness tears, and fatty infiltration of the rotator cuff muscles at the time of initial diagnosis.

Conclusion:

Non-operative management is indicated for patients with lower functional demands and moderate symptoms, and/or of course for those refusing to have surgery. Close routinely monitoring regarding development of tear size should be performed, especially in patients that remain symptomatic during nonoperative treatment. To ensure judicious patient counseling, it has to be taken into account that 1) tears that are initially graded as reparable may become irreparable over time, and 2) results after secondary surgical therapy after failed nonoperative treatment are usually reported to be inferior to those who underwent primary tendon repair.

Keywords: Conservative treatment, clinical outcomes, injections, non-operative treatment, physical therapy, rotator cuff, rotator cuff tear.